| NPI | 1427175108 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEEDEE HARDEE VAUGHTERS Practice Manager 803-648-3130 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: SC 22809) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2024-06-28 |